The Sound of Music, As Reported By Adult Cochlear Implant Users.

1. The Sound of Music, As Reported By Adult Cochlear Implant Users. Valerie LOOI (PhD; RMT; MAudSA-CC) & Jennifer SHE Dept. of Communication Disorders, The University of Canterbury, Christchurch, NZ.

2. Sensorineural HearingLoss Conductive HearingLoss Outer EarMiddle Ear Inner Ear 8th Nerve THE HEARING SYSTEM

4. HEARING AIDS AIM: To improve communication by making it audible Behind-The-Ear In-The-Ear

5. COCHLEAR IMPLANTS • Electronic listening device with surgically implanted electrodes coupled to external components. • Suitable for moderately-severe to profound sensorineural hearing losses. • Both adults & children.

6. Speech Processors • Behind-The-Ear • Esprit3G • Freedom • Body-Level • SPRint • Freedom Pictures courtesy: Cochlear Ltd.

7. F

8. CI vs HA • A powerful hearing aid (HA) may not allow access to all of the speech sounds. • CI considered if allows greater access to speech sounds. • Assessments conducted to establish if CI has better potential than HAs.

9. CURRENT CI CRITERIA • Moderately-severe to profound bilateral sensorineural loss. • Speech: <40% in worse ear (& <70% in better ear). • No middle ear complications.

10. Background • Postlingually deafened adult CI users are less accurate at perceiving musical sounds, and rate music to be less enjoyable post-CI than pre-CI. (Gfellar et al. 1998, 2000, 2002, 2003, Mirza et al., 2003). • However CI users rate music to sound more pleasant than HA users with the same level of hearing loss. (Looi et al., 2007, 2008). • Spend less time listening to music post-surgery. Some report that they avoid listening to music. • However existing studies have insufficient detail on factors CI users feel contribute to their poor ratings for music. WHY don’t they like it?

11. Aim • To develop & administer a questionnaire that collects unique and detailed information on CI user’s music perception & appreciation.

12. UCMLQ TheUniversity of Canterbury Music Listening Questionnaire. • 48 questions divided into 7 sections: • Music Listening & Musical Background • The Sound Quality of Musical Instruments, Instrumental Families & Voice • Musical Styles • Music Preferences • Music Recognition • Factors Affecting Music Listening Enjoyment • Music Training Program • ~ 1 hr ± ½ hr to complete.

13. 1) Music Listening & B’ground • Subject Factors. • Difference CI made. • Time spent listening to music, and enjoyment of music: Pre-hearing loss, Time just prior to getting CI, Now with CI. • Formal music training, and music participation: Pre-CI, & Post-CI. • Device(s) used for listening to music (e.g. CI+HA, CI-only, HA-only). • Music listening preferences (e.g. style).

14. 2) Sound Quality - Instruments • Rate the sound quality of:

15. 2) Sound Quality - Instruments Rating Scales: • Unpleasant – Pleasant • Unnatural – Natural • Emptier – As Expected – Fuller • Duller – As Expected – Sharper • More Noisy – As Expected – Less Noisy • Tinnier – As Expected – Richer • Rougher – As Expected – Smooth (As expect it to sound to someone with NH).

16. 3) Sound Quality - Styles • Unpleasant – Pleasant; • Simple – Complex; • Can never follow melody line – Can always follow melody line; • Can never identify this style by listening-alone – Can always identify this style by listening-alone; • Sounds nothing like I would expect it to sound to a person with NH – Sounds exactly as I would expect it to sound to a person with NH .

17. UCMLQ – Part 4-6 Part 4: Music Preferences • Preferences for different instruments, voices, instrumentations & group sizes. Part 5: Music Recognition • Instruments & tunes can always recognise. • Instruments & tunes would like to be able to recognise. Part 6: Factors Affecting Listening Enjoyment • If certain variables make music listening more enjoyable, less enjoyable, or no difference. Part 7: Questions on the Music Training Program

18. Response Rate • The questionnaire was sent to 221 adult CI users. • 133 (60%) questionnaires were returned. Of these: • 100 were completed (45%). • Subject characteristics (n=100): • Age: M = 62.1y (R: 18-88y); • Length CI use: M = 4.11y (R: 10mths-19y).

19. Results – Music Listening •  time spent listening to music AND  enjoyment levels now with CI than pre-hearing loss(p<0.001; paired t-test). •  time spent listening to music AND enjoyment levels now with CI than just prior to getting CI(p=0.003; paired t-test). • Post-surgery - Only 1/100 had formal music training, and 9/100 participated in musical activities. • 57% hadn’t tried to improve music listening or enjoyment since getting CI.

20. Devices for music listening • 37/93 (40%) noticed difference between CI-only & CI+HA. Of these 37 subjects, 93% preferred CI+HA. • 31/81 (38%) noticed difference between CI-only & HA-only. Of these 31 subjects, 82% preferred CI-only.

21. Instrument Ratings • Instruments rated ‘most pleasant & natural’: • Guitar • Male Singer • Piano • Least pleasant & natural: Brass

22. Instrument Ratings • For scales with ‘as expected’ as a mid-point, 1-sample t-test used to see if ratings were significantly different to how subjects expect the instrument(s) to sound to a NH person.

23. Instrumental Preferences N=88 N=88

24. Instrumental Preferences N=86

25. Preferred Group Size • Asked to rank preferred group size (1, 2, 3 performers, Small group, Large group). • 63/89 ranked 1 performer as most preferred. 59 ranked ‘Large group’ as least preferred. • Post-hoc Tukey test: Significantly preferred less performers to more. (e.g. 1 performer preferred to 2 or 3 performers or groups).

26. Musical Styles • Highest rated style – Country & Western. • Lowest rated style – Orchestra.

27. Factors affecting listening

28. Skills important for MTP • Skills most often rated as the most important to help music listening enjoyment: • Recognising tunes known prior to implantation. • Recognising commonly-known tunes. • Recognising commonly-known instruments. • Being able to hear pitch changes. • Being able to pick out the tune when presented with accompaniment.

29. Overall findings • CI+HA better than CI-only for music listening. • Generally, instruments tend to sound emptier, noisier, tinnier & rougher than CI users expect that they’d sound to a person with NH. • Low pitch range preferred to high pitch range. • Fewer performers preferred to larger groups. • Country & Western highest-rated style; Orchestra poorest rated.

30. Implications for RMTs • Music may not sound normal. • May not hear pitch in the same way as we do. • May not hear melodies ‘correctly’, or may not recognise melodies they say they know. • Low pitch instruments/music may be better • Start simple: Clear rhythm & words. 1 instrument. • Assess ability to perceive music & pitch. • May not enjoy music. • Check the listening environment & acoustics. • Children are different to adults – learnt to hear music through the CI.

31. “The implant has given me so much, but I still really grieve for real music. Music can elicit so many emotions and bring such pleasure, it is like having a large part of life missing!...It does not bring the same pleasure or emotion that it did when I was fully hearing…” (Sbjt #183)

32. References • Gfeller, K., Christ, A., Knutson, J., Witt, S., & Mehr, M. (2003). The effects of familiarity and complexity on appraisal of complex songs by cochlear implant recipients and normal hearing adults. Journal of Music Therapy, 40, 78-112. • Gfeller, K., Christ, A., Knutson, J. F., Witt, S., Murray, K. T., & Tyler, R. S. (2000). Musical backgrounds, listening habits, and aesthetic enjoyment of adult cochlear implant recipients. Journal of the American Academy of Audiology, 11, 390-406. • Gfeller, K., Witt, S., Adamek, M., Mehr, M., Rogers, J., Stordahl, J., et al. (2002). Effects of training on timbre recognition and appraisal by postlingually deafened cochlear implant recipients. Journal of the American Academy of Audiology, 13(3), 132-145. • Gfeller, K., Witt, S., Stordahl, J., Mehr, M., & Woodworth, G. (2000). The effects of training on melody recognition and appraisal by adult cochlear implant recipients. Journal of the Academy of Rehabilitative Audiology, 33, 115-138. • Looi, V., McDermott H. J., McKay, C. M., & Hickson, L. M. (2008). Music perception of cochlear implant users compared to that of hearing aid users. Ear and Hearing, 29(3), 421-434. • Looi, V., McDermott H. J., McKay, C. M., & Hickson, L. M. (2008). The effect of cochlear implantation on music perception by adults with usable pre-operative acoustic hearing. The International Journal of Audiology, 47(5), 257-268. • Looi, V., McDermott H. J., McKay, C. M., & Hickson, L. M. (2007). Comparisons of quality ratings for music by cochlear implant and hearing aid users. Ear and Hearing, 28(2 Supplement), 59S-61S. • Mirza, S., Douglas, S.A., Lindsey, P., Hildreth, T., & Hawthorne, M. (2003). Appreciation of music in adult patients with cochlear implants: a patient questionnaire. Cochlear Implants International, 4 (2.)

33. Acknowledgements • Funding: Co-operative Research Centre for Cochlear Implant & Hearing Aid Innovation (Melbourne, Australia). • Dr Peter Busby & Dr Pam Dawson from Cochlear Ltd. for advice and assistance. • Ms Prue Humber for administrative assistance.